Transcript PowerPoint Presentation - Endoscopic vs. Surgical

Palliation With Endoluminal
Stents
Todd H. Baron, M.D., F.A.C.P.
Professor of Medicine
Gastroenterology & Hepatology
Mayo Clinic College of Medicine
Enteral Stents
Malignant Gastric Outlet
Obstruction
Clinical Situations
• Unresectable CA
pancreatic, GB, Cholangio
• Metastatic disease
• Local invasion - colon
• Gastric CA
• primary
• Recurrent
SEMS: Overview
• May be placed endoscopically or
radiologically
• Non-TTS difficult but possible
• TTS placement - can be placed
beyond ligament of Treitz - uncovered
Wallstent
• Delivery diameter: 10F
• Deployed diameter:
20mm
22mm
• TTS
Cost of Palliation: Pancreatic CA
ENDO
GASTRO-J
Number of patients
12
15
Median survival (days)
94
92
NS
Median charges incurred
$9921
$28,173
< 0.005
Median hospitalization
stay required (days)
4
14
< 0.005
Number requiring repeat procedures
and hospitalization
7 (58.3%)
Yim, et al., GIE, 2001
15 (100%)
p
Malignant Colorectal
Obstruction
Metal Colonic Stents
• Wilson-Cook Z stent
• Microvasive Wallstent
• Precision Ultraflex Colonic
OTHER
• Ultraflex Esophageal Stent
Colonic Z-Stent
• Delivery diameter:
10mm (30F)
• Deployed diameter:
35/25mm
Indications for Colorectal Stents
• Pre-operative
• Palliative
• Indeterminate
Potential Benefits of
Pre-operative Colon Stents
•
•
•
•
•
One-stage operation
Reduced costs
Improved QOL
Elective operation
Pre-operative assessment
tumor resectability
patient operability
Complications of Enteral Stents
• Tumor ingrowth/overgrowth
• Migration
• Perforation
immediate
delayed
• Impaction
• Bleeding
• Pain/Tenesmus
Conclusions
• SEMS are effective for closing TEF
and treating all forms of malignant
esophageal obstruction
• SEMS are cost-effective for palliation
of malignant GOO for pancreatic CA
• SEMS can be used for both preoperative and palliative treatment of
malignant colonic obstruction